FARMAKOLOGI

DIABETES

NASRUHAN ARIFIANTO
 DIABETES MELLITUS

Sekelompok gangguan metabolik kronik, ditandai

oleh hiperglikemia
Berhubungan abnormalitas metabolisme,
karbohidrat, lemak, protein
Disebabkan defek sekresi insulin, sensitivitas
insulin atau keduanya
Komplikasi kronis mikrovaskular, makrovaskular
dan neuropati

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 BATASAN DIABETES MELLITUS
Kriteria diagnostik DM apabila terdapat gejala DM (poliuri,
polidipsi, polifagi dan penurunan berat badan tanpa sebab
yang jelas) ditambah salah satu dari :

1. GDA 200 mg/dl ( 11,1 mmol/L)

Acak --- waktu kapapun tanpa memperhatikan jangka waktu
sejak terakhir makan

2. GDP 126 mg/dl (7 mmol/L).

Puasa --- tidak ada asupan kalori selama 8 jam

3. GD 200 mg/dl sesudah beban glukosa 75 g pada TTGO

Apabila tidak terdapat gejala DM maka harus terdapat hasil dua

dari kadar glukosa yang telah disebutkan di atas

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KLASIFIKASI DIABETES MELLITUS

DM tipe I karena destruksi sel beta---defisiensi insulin absolut

DM tipe II karena resistensi insulin dan atau defek sekresi insul
DM tipe lain :
penyakit dari pankreas eksokrin (pankreatitis, Neoplasia)
endokrinopati (al. acromegaly, cushing syndrome)
induksi obat atau zat kimia dan lain2
DM Gestasional
 DIAGNOSING DIABETES

Type 1 Type 2
1. < 10% of DM 1. > 90% of DM
2. Onset usually in 2. Onset adulthood but
childhood or now common in
adolescence adolescence
3. Loss of beta cells in
the pancreas: insulin 3. Insulin resistance so
requiring high insulin levels
4. Weight loss is 4. Obesity is prevalent
prevalent 5. Insidious onset
5. Sudden onset
6. Screening for
6. Screening for complications begins
complications begins at diagnosis
5 years after
diagnosis
TERAPI - DIABETES MELLITUS

Pengendalian kadar glukosa darah sepanjang hari pada

rentang acceptable
Menjaga pertumbuhan dan perkembangan normal pada
anak-anak
Menghindarkan gejala DM
Meminimalkan dan mencegah komplikasi
Menghindarkan hipoglikemia

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GOALS OF THERAPY ADA ACE dan
Parameter
AACE
Preprandial plasma glucose 90-130 110
(mg/dl)

Postprandial plasma <180 <140

glucose (mg/dl)

Hemoglobin A1C <7 <6,5

ADA - American Diabetes Association
ACE - American College of Endocrinology
AACE-American Association of Endocrinologist
 TERAPI DIABETES MELLITUS

NON OBAT
latihan/excersise
diet
restriksi alkohol/rokok

OBAT
Insulin
Oral Anti Diabet

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 INSULIN
Weight gain outweighed by glucose control
Average dose 0.6-0.8 units/kg body weight/day
~ 40-50 units for a 70 kg man
Half for basal needs and half with meals
Bioavailability changes with site of injection*
Faster in abdomen, Slower in thigh
Exercise accelerates absorption in thigh*
Arm reduces exercise induced hypoglycemia by 60%
Abdomen reduces exercise induced hypoglycemia by 90%
Best combination: long-acting basal and rapid acting
syntheticmost closely mimics normal*
 Pharmacokinetics of Various Insulins
Administered Subcutaneusly
Type of Insulin Onset (h) Peak (h) Effective
Duration (h)
Rapid acting
Aspart 0.5 1-2 3.5
Lispro < 0.25 0.5-1.5 3-4
Short acting
Regular 0.5-1.0 2-3 3-6
Intermediat acting
NPH 2-4 6-10 10-16
Lente 3-4 6-12 12-18
Long acting
Ultra lente 6-10 10-16 18-20
Glargine 4 - 24

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Premixed?? 30/70, 50/50
TEMPAT KERJA OBAT ANTIDIABETES
SULFONYLUREAS
Action :
Stimulate pancreatic beta cells to release insulin
Weight gain and hypoglycemia*
Can be used in low doses in the elderly
OK in mild renal dysfunction and cardiopulmonary co-
morbidities (sleep apnea, CHF)
 SULFONYLUREAS

1st generation:
TOLBUTAMIDE
CHLORPROPAMIDE
TOLAZAMIDE
2nd generation:
GLYBENCLAMIDE
GLYBURIDE
GLIPIZIDE
GLYMEPRIDE
3rd generation:
GLYCLAZIDE

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MEGLITINIDES

REPAGLINIDE , NATEGLINIDE

Action :
Rapid acting insulin secretagogues
Half life < 1 hour
May be used in the elderly, renal failure, and
cardiopulmonary disorders
Very helpful for erratic eating schedules
 METFORMIN
Action :
Insulin sensitizer,
Decreases glucose
production in the
liver,
THIAZOLIDINEDIONE
PIOGLITAZONE
Action :
Decreases insulin resistance*,
gluconeogenesis
Use with caution in the elderly due to declining
ventricular function, and in cardiopulmonary
disorders due to volume overload*
ALPHA GLUCOSIDASE INHIBITORS

ACARBOSE , MIGLITOL
Action :
Delay carbohydrate absorption in gutdecreases peak
glucose levels, no hypoglycemia
Acarbose may delay onset of type 2 diabetes
Reduce the risk of cardiovascular events*
DPP-4 INHIBITORS
SITAGLIPTIN , SAXAGLIPTIN, LINAGLIPTIN, VILDAGLIPTIN

Action :
Block dipeptidyl peptidase 4 (the enzyme that breaks down
natural incretins)
Better insulin release and blood sugar control particularly
postprandial
SINAU TENANAN YO REK.